Conducting online OSCEs aided by a novel time management web-based system.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are an essential part of the assessment process for medical students. They have traditionally been face-to-face assessments, however, due to the COVID-19 pandemic, medical schools have been forced to attempt to carry them out remotely. OSCEs are difficult to carry out online due to rotation management aspects which make it difficult to synchronize movement of students from one station to another. METHODS: The authors have developed a dynamic OSCE time management website which aids in solving the movement synchronization issue. This secure website enables participants to view the list of stations they are allowed to enter, and the start and end time of each station. OSCE administrators can control time of entry and monitor progress of the OSCE remotely. RESULTS: The authors have used the system to conduct several exams successfully, showing the feasibility and cost effectiveness of this method, as well as user acceptance and satisfaction. In contrast to traditional OSCEs, students are set up in individual virtual rooms for the whole exam while examiners, simulated patients and proctors rotate between them. CONCLUSIONS: This online OSCE implementation shows feasibility, cost effectiveness and acceptance of this method. The authors found that student outcomes are comparable to traditional OSCEs conducted in the past. There was no significant difference in student marks in one exam compared to last year, while marks were slightly higher in two exams, potentially due to lack of physical exam stations. An unresolved drawback is the inability to assess physical exam stations online, although having students verbally describe what they would do in physical exam situations may be a partial solution.

QUALITY AND USE OF FREE SMOKING CESSATION APPS FOR SMARTPHONES.

OBJECTIVES: Smartphone Apps are one of the tools available to support patients who wish to quit smoking. Content analysis studies have indicated multiple deficiencies within these Apps including minimal use of evidence-based research and Nicotine Dependence Treatment Provider (NDTP) in App development. The aim of this study was to determine quality and features of smoking cessation Apps available on Android® and iOS® platforms. METHODS: The first fifty free smoking cessation Apps available for download using the search term smoking cessation on Google Play Store and Apple App Store were chosen. Each of these Apps was analyzed and categorized based on ratings, target audience age, language, and a variety of tracking functionalities noted on the Apps. Indications and suggestions regarding either the use of NDTP or evidence-based behavior change protocols were noted. RESULTS: There were no significant differences in the features of smoking cessation Apps on Android and iOS. Only 15 percent of all Apps analyzed on both platforms indicated some involvement of NDTP and there was no difference between the two platforms. More than 50 percent of Apps studied were downloaded over half a million times and the average user rating was 3.89/5.00 for Android and 3.72/5.00 for iOS with no significant difference. CONCLUSIONS: Most smoking cessation Apps in both platforms offer basic tracking functionalities with limited motivational tips. Only a handful of Apps have moved beyond this role and while their development is applaudable much innovation remains.

Do senior medical students meet recommended emergency medicine curricula requirements?

BACKGROUND: Emergency departments (EDs) offer a variety of learning opportunities for undergraduate medical students. It is however, difficult to evaluate whether they are receiving recommended training during their emergency medicine (EM) clerkship without identifying their clinical activities. We aimed to evaluate the clinical exposure of the final year medical students at our College during their EM clerkship. METHODS: This is a retrospective analysis of prospectively collected student logbooks. 75 students rotated in a 4-week EM clerkship during 2015-2016. The students rotated in EDs of two hospitals. Each ED treats more than 120,000 cases annually. The students completed 12 eight-hours shifts. Presentations and procedures seen were compared with EM curriculum recommendations. RESULTS: Five thousand one hundred twenty-two patient presentations and 3246 procedures were recorded in the logbooks, an average (SD) of 68.3 (17.6) patients and 46.1 (14.0) procedures. None of the students encountered all ten recommended presentations. Two students (2.6%) logged all nine procedure categories of the EM curriculum. CONCLUSION: Recommended presentations and procedures of the EM clerkship were not fully encountered by all our students. Different settings vary in the availability and type of patients and procedures. Each clinical clerkship should tailor their teaching methods based on the available learning opportunities.

Reducing the physician workforce crisis: Career choice and graduate medical education reform in an emerging Arab country.

BACKGROUND: In today's interdependent world, issues of physician shortages, skill imbalances and maldistribution affect all countries. In the United Arab Emirates (UAE), a nation that has historically imported its physician manpower, there is sustained investment in educational infrastructure to meet the population's healthcare needs. However, policy development and workforce planning are often hampered by limited data regarding the career choice of physicians-in-training. The purpose of this study was to determine the specialty career choice of applicants to postgraduate training programs in the UAE and factors that influence their decisions, in an effort to inform educational and health policy reform. To our knowledge, this is the first study of career preferences for UAE residency applicants. METHODS: All applicants to residency programs in the UAE in 2013 were given an electronic questionnaire, which collected demographic data, specialty preference, and factors that affected their choice. Differences were calculated using the t-test statistic. RESULTS: Of 512 applicants, 378 participated (74%). The most preferred residency programs included internal medicine, pediatrics, emergency medicine and family medicine. A variety of clinical experience, academic reputation of the hospital, and international accreditation were leading determinants of career choice. Potential future income was not a significant contributing factor. DISCUSSION: Applicants to UAE residency programs predominantly selected primary care careers, with the exception of obstetrics. The results of this study can serve as a springboard for curricular and policy changes throughout the continuum of medical education, with the ultimate goal of training future generations of primary care clinicians who can meet the country's healthcare needs. As 65% of respondents trained in medical schools outside of the UAE, our results may be indicative of medical student career choice in countries throughout the Arab world.

Factors influencing medical students' self-assessment of examination performance accuracy: A United Arab Emirates study.

BACKGROUND: Assessment of one's academic capabilities is essential to being an effective, self-directed, life-long learner. The primary objective of this study was to analyze self-assessment accuracy of medical students attending the College of Medicine and Health Sciences, United Arab Emirates University, by examining their ability to assess their own performance on an MCQ examination. METHODS: 1 st and 2 nd year medical students (n = 235) self-assessed pre and post-examination performance were compared with objectively measured scores (actual examination performance). Associations between accuracy of score prediction (pre and post assessment), and students' gender, year of education, perceived preparation, confidence and anxiety were also determined. RESULTS: Expected mark correlated significantly with objectively assessed marks (r = 0.407; P < 0.01) but with low predictability (R 2 = 0.166). The average objectively determined mark was 69% and the average expected mark was equivalent to 83%; indicating that students significantly overestimate their examination performance. Self-assessed pre-examination score range was significantly different between males and females (P < 0.05) with females expecting higher marks. Preparation and confidence correlated significantly with actual examination score (P < 0.05; r = 0.459 and 0.569 respectively). DISCUSSION: Gender, self-reported preparation and confidence are associated with self-assessment accuracy. Findings reinforce existing evidence indicating that medical students are poor self-assessors. There are potentially multiple explanations for misjudgment of this multidimensional construct that require further investigation and change in learning cultures. The study offers clear targets for change aimed at optimizing self-assessment capabilities.

An Enhancement-focused framework for developing high quality single best answer multiple choice questions.

BACKGROUND: The primary goal of any assessment of students is to provide valid and reliable evaluations of students' knowledge and skills as well as provision of accurate feedback to students about their performance. Contrary to best practice guidelines for development of multiple choice questions (MCQs), however, items used within medical schools are often flawed. This disappoints students and discourages examiners from using in-house MCQ databases. Vetting and reviewing items can improve the quality of MCQs. In this paper, we describe our approach to standardize the format used for MCQ assessment and provide recommendations for quality enhancement of high-stakes assessment. METHODS: A collaborative enhancement-focused vetting and review approach to development of high quality single best answer MCQs has been described. RESULTS: Implementation of a collaborative strategy to blueprint, vet, review and standard set MCQ items for high stakes examinations can effectively contribute to assessment quality assurance. Similarly, shared responsibility for post examination analyses of items may reveal the psychometric properties of items in need of improvement and contribute to closure of the assessment outcomes feedback loop. DISCUSSION: Devolving responsibility for implementation of assessment processes as an integral part of educational practices and values can maximize reliability and standards of assessment processes. We contend that while logistics and time constraints are of concern to busy faculty members, judicious utilization of resources to develop well-written MCQ items are well worth the effort to produce reliable and valid examinee scores. An enhancement-focused approach can be institutionally rewarding and lead to improved quality of high stakes assessments.

Superficial and deep learning approaches among medical students in an interdisciplinary integrated curriculum.

INTRODUCTION: Students' learning approaches have a significant impact on the success of the educational experience, and a mismatch between instructional methods and the learning approach is very likely to create an obstacle to learning. Educational institutes' understanding of students' learning approaches allows those institutes to introduce changes in their curriculum content, instructional format, and assessment methods that will allow students to adopt deep learning techniques and critical thinking. The objective of this study was to determine and compare learning approaches among medical students following an interdisciplinary integrated curriculum. METHODS: This was a cross-sectional study in which an electronic questionnaire using the Biggs two-factor Study Process Questionnaire (SPQ) with 20 questions was administered. RESULTS: Of a total of 402 students at the medical school, 214 (53.2%) completed the questionnaire. There was a significant difference in the mean score of superficial approach, motive and strategy between students in the six medical school years. However, no significant difference was observed in the mean score of deep approach, motive and strategy. The mean score for years 1 and 2 showed a significantly higher surface approach, surface motive and surface strategy when compared with students in years 4-6 in medical school. DISCUSSION: The superficial approach to learning was mostly preferred among first and second year medical students, and the least preferred among students in the final clinical years. These results may be useful in creating future teaching, learning and assessment strategies aiming to enhance a deep learning approach among medical students. Future studies are needed to investigate the reason for the preferred superficial approach among medical students in their early years of study.

Health insurance reform and the development of health insurance plans: the case of the Emirate of Abu Dhabi, UAE.

INTRODUCTION: The Emirate of Abu Dhabi has taken concrete steps to reform health insurance by improving the access to health providers as well as freedom of choice. The growing cost of health care and the impact of the global financial crisis have meant that countries are no longer able to solely bear the cost. As a result many countries have sought to overhaul their health care system so as to share the burden of provision with the private sector whether it is health care plan providers or employers. OBJECTIVES: This article explores and discusses how the policy issues inherent in private health care schemes have been dealt with by the Emirate of Abu Dhabi. METHODS: Data was collected in early 2013 on health care plans in Abu Dhabi from government sources. RESULTS: The Abu Dhabi model has private sector involvement but the government sets prices and benefits. The Abu Dhabi model adequately deals with the problem of adverse selection through making insurance coverage a mandatory requirement. There are issues with moral hazards, which are a combination of individual and medical practitioner behavior that might affect the efficiency of the system. Over time there is a general increase in the usage of medical services, which may be reflective of greater awareness of the policy and its benefits as well as lifestyle change. CONCLUSION: Although the current health care system level of usage is adequate for the current population, as the level of usage increases, the government may face a financial burden. Therefore, the government needs to place safeguards in order to limit its exposure. The market for medical treatment needs to be made more competitive to reduce monopolistic behavior. The government needs to make individuals aware of a healthier lifestyle and encourage precautionary actions.

Relationship between admission selection tools and student attrition in the early years of medical school.

Objectives: Placement in medical schools is highly sought after worldwide with fierce competition among applicants. However, some of the best students withdraw after being accepted to medical school. The aim of this study was to investigate early student attrition within the first 2 years of medical school and determine its relationship to admission selection tools. Methods: Quantitative research was conducted at the College of Medicine and Health Sciences from 2016 until 2020, during which time routine admission data and students' examination results for the first 2 years were collected and analyzed. Results: The attrition rate during the study period was 31.7%. High school and college written examination scores were significantly related to completing the premedical program (p = 0.001 and p = 0.002, respectively). Female students scored significantly higher in multiple mini interviews (MMIs) compared with male counterparts (p < 0.001). However, the difference in MMI score was not related to student attrition (p = 0.148). Conclusion: The cause of early attrition is complex and cannot be attributed to a single factor.Undergraduate high school score and written admission examination results were statistically significant factors in relation to student attrition rate and low academic performance. The results of this study showed that the female students scored significantly higher in the multiple MMI tests compared to male students. However, MMI score alone was not significantly related to student attrition.

Impact of COVID-19 restrictions on health and well-being in the United Arab Emirates.

Background: Restrictions during the COVID-19 pandemic are thought to have impacted both the physical health and well-being of individuals where lockdown was applied. The United Arab Emirates (UAE) was one of the leading countries in implementing the international guidelines to limit the intensely contagious nature of the outbreak. Aim: To identify the impact of COVID-19 on changes to exercise and general physical activity habits, changes to the consumption of various foods and potential weight gain, as well as any differences in smoking habits among individuals residing in the UAE during the COVID-19 quarantine. Methods: This is a cross-sectional analytical study that used a quantitative electronic questionnaire sent by the Ministry of Health and Prevention to individuals on its platform in order to collect data on the physical health and well-being of a UAE sample population. A total of 2,362 responses were received to specific questions on physical activity, eating habits, and tobacco use for the period before, during, and after the COVID-19 lockdown. Descriptive statistical analysis was used to display the sample's demographic data and the changes in physical health and well-being. Paired t-test was used to show the changes in dietary habits. Results: This study reveals concerning changes in health risk behaviors during the COVID-19 lockdown in the UAE. Physical activity levels declined across mild, moderate and vigorous ranges in most participants. Alarmingly, sedentary behavior dramatically increased with 71% of participants spending an average of 4-8 h per day sitting and over 54% of participants spending more than 4 h watching TV on an average day during lockdown. Fast-food consumption and snacking rose, hence weight gain was observed in over 53% of participants. Smoking habits, especially among cigarette smokers, may have worsened, with 45.2% reporting an increase in cigarette smoking, 16.8% declaring an increase in shisha smoking and 35.3% reporting an increase in smoking other tobacco products. These unfavorable behaviors during confinement could have serious long-term health consequences. Conclusion: This study demonstrates that long periods of home quarantine may have led to unhealthy consequences that increase the risk of developing disease. This study therefore aims to highlight these health impacts, and recommend strategies and policies that can encourage healthy habits.

Practical Guide to Undergraduate Medical Curriculum Alignment and Mapping.

Objective: Curriculum development and reviews are of paramount importance for academic programs curriculum management. Medical curricula need proper construction and frequent updates to suits learning outcomes considering their integrative nature and rapid scientific advancement. Curriculum alignment and mapping are fundamental for proper integration and planning of medical curriculum. This process is beneficial in detecting gaps and redundancies, and ensuring proper instruction, integration, and transparency. However, there is a paucity in the literature of a practical guidance to such process. Hence, this manuscript provides a practical guidance that was adopted in our institutes. Methods: A detailed description of twelve step-by-step guidance to curriculum alignment and mapping was provided. The process needed for each step and the flow chart of work was detailed. Results: This guide was developed and implemented successfully. Among many benefits encountered, many gaps in the contents, learning outcomes and assessment methods were detected and rectified. Additionally, better curriculum integration has been achieved. The current mapping will make any future curriculum reviews easier. Conclusion: This guide could be utilized by newly developed and existing programs for curriculum alignment and mapping. It fills a gap in academic literature through stepwise workflow which has been tested and implemented.

Reflections on medical student evaluations of a public health clerkship.

Introduction: The COVID-19 pandemic demonstrated the need for skilled medical practitioners in public health, and outbreak investigations. The College of Medicine and Health Sciences at the United Arab Emirates University (UAEU) introduced a clerkship in public health constituting theoretical and practical sessions to 5th year medical students in 2015. The aim of this study is to explore the satisfaction of the students with the public health clerkship which is crucial for the assessment and reformation of the taught curriculum. Methods: A cross-sectional, post-evaluation analysis was conducted from the period 2015-2022. The evaluation questionnaire was conducted via an online university system. The survey contained 5 themes: pre-course instructions, structure of the clerkship, academic staff, activities, and learning outcomes. Ethics approval was secured from the Social-IRB of the UAEU. We used SPSS version 26 to analyze the data using independent t-test and ANOVA. Results: One hundred and seventy four students (27.4% response rate) participated in the study. Overall, the students had an average satisfaction score of 2.86 out of 4. The majority of the students reported having a good understanding of public health (93.7%), improving their oral presentation skills (91.2%), and developing new skills (87.2%). Furthermore, more than 9 in 10 students (96.1%) reported that the program expanded their knowledge, skills, and confidence. The mass (90.2%) of students agreed that the clerkship content was covered in sufficient depth, majority of the students agreed that they had received enough information about the clerkship before it started (74.6%), majority of the students agreed that the faculty were interested in their personal development (86.1%) The students who completed the clerkship prior to the COVID-19 pandemic had a statistically significant (P = 0.02) higher average rating (72.8%) than students who completed the clerkship during the pandemic (71.1%). Discussion: Medical students at the UAEU were satisfied with the activities and delivery of the public health clerkship and found it rewarding. Conducting needs assessment and proposal writing provided them with the knowledge, skills, and confidence to conduct research in their career. These findings may be useful in helping and support other institutes to plan and develop a clerkship in the public health.

Multiple authorship and article type in journals of urology across the Atlantic: trends over the past six decades.

OBJECTIVE: The aim of this research was to study the trends in authorship and type of article in European and North American journals of urology over the past 6 decades. MATERIALS AND METHODS: Using a self-developed Visual Basic program, the number of authors per article and the type of article in four European journals (BJU International, Current Opinion in Urology, European Urology and Urologia Internationalis) and four North American journals (Journal of Urology, Urologic Clinics of North America, Urology and World Journal of Urology) were extracted from the PubMed website from January 1946 to October 2010, and the number of authors per article in each year was calculated in all the journals. RESULTS: The average number of authors per article has increased and the percentage of single-author articles has decreased in both European and American journals. An increase in the number of authors per article was observed mainly in original articles and case reports. Since the early 1980s, there has also been a decreasing percentage of published case reports and a general increase in the percentage of letters to the editor and editorials. CONCLUSIONS: The multiple-authorship trends observed in both European and North American urology journals were similar and appeared to be mainly due to changes in original articles and case reports.

Oral cancer prevention and early detection: knowledge and practice among Saudi Arabian healthcare practitioners.

PURPOSE: Despite the crucial role that healthcare practitioners (HCPs) have in preventing and detecting oral cancer (OC), studies suggest that dentists and physicians do not adequately detect early stage OC which is attributed to their attitude and knowledge. This Saudi Arabian study aims to assess HCP's knowledge and practice vis-à-vis OC's risk factors and patient evaluation. DESIGN/METHODOLOGY/APPROACH: A questionnaire was distributed to HCPs in six different Saudi Arabian settings. A total of 16 items representing a mixture of OC's risk and non-risk factors were measured. FINDINGS: The study found that only 20.9 percent of HCPs could distinguish 11 items or more correctly. Additionally, when HCPs obtained the patient's medical history, no more than 32.3 percent routinely assessed ten important OC issues. Almost 36 percent of HCPs thought that attending to too many patients prevented them from taking proper medical histories, and 37.6 percent admitted that more training in preventing and detecting OC is needed. RESEARCH LIMITATIONS/IMPLICATIONS: Since there is no effective automated system to reach Saudi Arabian practitioners, the number of practitioners involved in this study is limited. PRACTICAL IMPLICATIONS: The knowledge and practice of HCPs with relation to OC do not appear to be sufficient and HCPs should have better and more training in OC prevention and early detection. ORIGINALITY/VALUE: It appears that Saudi Arabian HCPs do not adequately participate in OC's prevention and early detection. It is suggested that continuous education strategies in Saudi Arabia should be reassessed and emphasis given to OC diagnosis.

Self-efficacy beliefs and expectations during an Emergency Medicine Clerkship.

BACKGROUND: Undergraduate emergency medicine (EM) training is important because all medical graduates are expected to have basic emergency knowledge and skills regardless of their future speciality. EM clerkship should provide opportunities to improve not only knowledge and skills but also the self-efficacy of learners. This study aims to evaluate the expectations, opinions, and self-efficacy beliefs of medical students during a 4-week mandatory EM clerkship. METHODS: This study used a prospective longitudinal design with quantitative and qualitative survey methods. It includes final year medical students of the 2015-2016 academic year. Voluntary de-identified pre- and post-clerkship surveys included 25 statements. The post-clerkship survey included two open-ended questions asking participants to identify the best and worst three aspects of EM clerkship. Responses were analysed to determine themes or commonalities in participant comments indicative of the EM clerkship learning experiences and environment. RESULTS: Sixty-seven out of seventy-nine (85%) students responded to both pre- and post-clerkship surveys. Medical students' expectations of EM clerkships' effect on knowledge and skill acquisition were high, and a 4-week mandatory EM clerkship was able to meet their expectations. Medical students had very high expectations of EM clerkships' educational environment. In most aspects, their experiences significantly exceeded their expectations (p value < 0.001). The only exception was the duration of clerkship, which was deemed insufficient both at the beginning and at the end (p value: 0.92). The students perceived that their self-efficacy improved significantly in the majority of basic EM skills and procedures (p value < 0.001). Emergent qualitative themes in the study also supported these results. CONCLUSION: This study showed that a 4-week mandatory EM clerkship increased medical students' perceived self-efficacy in basic emergency management skills. The EM clerkship met students' expectations on knowledge and skill acquisition, and exceeded students' expectations on educational environment.

Score Gains on the NBME Subject Examinations in Internal Medicine Among Clerkship Students: a Two-Year Longitudinal Study from the United Arab Emirates.

Background: The impact of clinical proficiency on individual student scores on the National Board of Medical Examiners (NBME) Subject Examinations remains uncertain. We hypothesised that increasing the length of time spent in a clinical environment would augment students' performance. Methods: Performance on the NBME Subject Examination in Internal Medicine (NBME-IM) of three student cohorts was observed longitudinally. Scores at the end of two unique internal medicine clerkships held at the third and fourth years were compared. The score differences between the two administrations were compared using paired t-tests, and the effect size was measured using Cohen's d. Moreover, linear regression was used to assess the correlation between the NBME-IM score gains and performance on a pre-clinical Comprehensive Basic Science Examination (CBSE). A two-tailed p-value <0.05 was considered significant. Results: Of the 236 students enrolled during the third year, age, gender, CBSE, and NBME-IM scores were similar across all cohorts. The normalised score gain on the NBME-IM at the fourth year was 9.5% (range -38 to +45%) with a Cohen's d of 0.47. However, a larger effect size with a Cohen's d value of 0.96 was observed among poorly scoring students. Performance on the CBSE was a significant predictor of score gain on the NBME-IM (R 0.51, R 2 0.26, p-value < 0.001). Conclusions: Despite the increased length of clinical exposure, modest improvement in students' performance on repeated NBME-IM examination was observed. Medical educators need to reconsider how the NBME-IM is used in clerkship assessments.

Transferable skills of incoming medical students and their development over the first academic year: The United Arab Emirates experience.

Increasingly, it is being recognised in higher and medical education that learners should be adequately prepared for the unpredictable nature of professional practice. Several generic or transferable skills or capabilities (e.g., communication, information handling) that will enable graduates to function in an ever-changing professional world have been identified. Using a validated inventory comprising six categories of transferable skills, three cohorts of incoming male and female medical students at a Gulf university documented their level of practice and confidence for 31 skills. The exercise was repeated a year later. New medical students identified computer and organisational skills and the ability to manage their learning as strengths, but scores for technical and numeracy, information handling and presentation and communication skills suggested that learners generally required guidance. A year later, despite considerable self-reported information handling and communication skills development, learners generally did not consider themselves self-sufficient. A significant gender difference emerged, with incoming males reporting less experience and confidence in many skills. This gap was reduced but did not disappear over the first academic year. An audit such as this may be useful for identifying individual skills levels as well as providing insight into shortcomings in the academic programme in terms of opportunities for transferable skills development.

Perceptions of healthcare practitioners in Saudi Arabia regarding their training in oral cancer prevention, and early detection.

PURPOSE: Healthcare practitioners (HCPs) have a major responsibility in the prevention and early detection of oral cancer (OC). Accordingly, adequate training in this area will positively enhance healthcare practitioners' accountability towards their patients. The present study was conducted in Saudi Arabia with the objective of assessing HCPs' opinion vis-a-vis OC prevention and early detection. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was distributed among HCPs in six different settings in Saudi Arabia. FINDINGS: Totals of 41.2 per cent and 63.4 per cent of HCPs thought that they are adequately trained to perform an OC examination and to palpate the lymph nodes, respectively. Similarly, 33.2 per cent and 25.8 per cent thought that they are adequately trained to provide tobacco and alcohol cessation education for their patients, respectively. Of HCPs, 45.1 per cent thought they had a low level of knowledge and training in OC prevention and the early detection thereof, 53.6 per cent agreed that their knowledge about OC was not current, and 82 per cent were comfortable with referring suspicious lesions to specialists. ORIGINALITY/VALUE: It appears that the current knowledge and training in OC prevention and early detection among HCPs in Saudi Arabia is not up to the desired level. Accordingly, it is suggested that OC prevention and early detection should be given the necessary attention when establishing new continuous education strategies in Saudi Arabia.

The use of phosphorescence oxygen analyzer to measure the effects of rotenone and 1-methyl-4-phenylpyridinium on striatal cellular respiration in C57BL6 mice.

BACKGROUND: We have previously reported on the use of the phosphorescence oxygen analyzer for measuring spinal cord cellular respiration. This analytical tool is used here to investigate the effects of two inhibitors of NADH:ubiquinone oxidoreductase, rotenone and 1-methyl-4-phenylpyridinium, on cellular respiration in striatal tissue. Both neurotoxins can induce Parkinson's disease-like symptoms, and have been used to study this disease in animals. Our hypothesis is that striatal cellular respiration is a sensitive biomarker for the adverse effects of toxins, and the phosphorescence oxygen analyzer can be used as a screening tool for this purpose. METHODS: Striatal fragments were collected from C57BL6 mice and immersed in Pd phosphor solution [phosphate-buffered saline, 3.0 µM 'Pd(II)-meso-tetra (sulfophenyl) tetrabenzoporphyrin' and 0.5% fat-free albumin, with and without 5.0 mM glucose]. The sample was transferred to a glass vial containing 2-mL Pd phosphor solution. The vial was sealed from air and placed in the instrument that measures dissolved oxygen as function of time. Immunoblots of the studied tissue were positive for the dopamine neuronal cell biomarker tyrosine hydroxylase. RESULTS: Striatal oxygen consumption was linear with time, exhibiting zero-order kinetics of oxygen reduction by cytochrome oxidase. Cyanide sensitive respiration was ≥90%, confirming oxygen was reduced by cytochrome oxidase. The rate of respiration increased by ~2-fold in the presence of glucose. Striatal oxygen consumption in the presence of rotenone or 1-methyl-4-phenylpyridinium was exponential, demonstrating impaired respiration. CONCLUSION: Striatal cellular mitochondrial oxygen consumption was impaired by the studied inhibitors of complex I of the respiratory chain. This effect is expected to deplete NAD+ (oxidized nicotinamide adenine dinucleotide), a principle driver of glycolysis. In vivo studies are required to determine if these toxin-induced metabolic derangements contribute to the development of sporadic Parkinson's disease. This analytic tool can be used to screen environmental toxins for their in vitro effects on the striatum.

Conserved spinal cord bioenergetics in experimental autoimmune encephalomyelitis in C57BL6 mice, measured using phosphorescence oxygen analyzer.

BACKGROUND: We have previously reported that spinal cord respiration (cellular mitochondrial oxygen consumption) and ATP content are conserved in the studied model of experimental autoimmune encephalomyelitis (EAE), foreseeing a recovery of the diseased rats. This exemplary lesion of multiple sclerosis is used here to measure spinal cord bioenergetics in C57BL6 mice. Our hypothesis is that, despite the well-known focal axonal mitochondrial pathology, bioenergetics of the CNS is reasonably preserved in this disease. METHODS: EAE was induced with an immunodominant myelin oligodendrocyte glycoprotein epitope in complete Freund's adjuvant, appended by injections of pertussis toxin. A low- and high-dose of the encephalitogen, administered into base of tail or hind-flank, were investigated. Control mice received only the incomplete adjuvant into tail. Oxygen measurements were based on quenching the phosphorescence of Pd(II) meso-tetra (sulfophenyl) tetrabenzoporphyrin by molecular oxygen. Cellular ATP was measured using the luciferin/luciferase system. RESULTS: The kinetics of spinal cord oxygen consumption was zero-order (linear with time) and inhibited by cyanide, confirming oxygen was reduced by cytochrome oxidase. The rate of respiration (in µM O2.min-1.mg-1; measured on Days 13-28) in control mice was (mean ± SD) 0.086 ± 0.024 (n = 8) and in immunized mice was 0.079 ± 0.020 (n = 15, P = 0.265, Mann-Whitney test). Consistently, cellular ATP (in µmol mg-1 dry pellet weight; measured on Days 13-28) in control mice was 0.068 ± 0.079 (n = 11) and in immunized mice was 0.063 ± 0.061 (n = 24, P = 0.887, Mann-Whitney U test). CONCLUSIONS: In vitro measurements of spinal cord bioenergetics show conservation of the mitochondrial function in mice with EAE. These results suggest the previously documented reduced mitochondrial electrochemical potential in this disease is alterable, and likely reflects the adverse events of neuroinflammation.